1. cost
2. motivation
3. restore
4. strategize

1. Respect, referrals
2. Accept more expensive or complex tx
3. DDS not required to collect data
4. Gives DDS for time for production
5. Increase prduct sales  

1. complete debridement
2. shallow pocket depth 4-6mm
3. edematous tissue
4. failure to respond to debridement therapy
5. tissue tags

1. Fibrotic tissue
2. Pocket depth greater than 6mm
3. Infrabony pockets
4. Acute necrotizing ulcerative gingivitis NUG
5. Thin, fragile tissue or mucosa
6. Lack of attached gingival
7. Frenum pulled gingiva
8. imcomplete debridement
9. systemic problems or meds leading to gingival enlargement

• Edematous, swollen, bluish-red gingiva w/ BOP
• Epithelial cells begin to migrate w/in 12-24hrs

Less edema color begin to return to normal

BOP still

Tissue forming

Epithelial cell progressing but not complete

• Edema almost gone
• Normal color
• Little to no BOP
• Epitheliaization almost complete
• Connective tissue organizing,collagen being produced

• Normal healthy firm tissue
• No BOP
• Connective tissue migration 21-28 days
• Keratinization increases

1. Sharpen instruments
2. Probe entire tooth
3. Evaluate tissue
4. Complete debridement
5. Explain procedure to pt
6. Have pt sign informed consent
7. Insure that the anesthesia is profound

1. Administer LA
2. Stabilize tissue with cotton swap
3. Use cutting edge against the tissue 11/12 on the distal an 13/14 on the mesial
4. Blade to tissue angle 45-90 degrees
5. Strokes are long, horizontal, and overlaping
6. Instrument pocket until no necrotic tissue or tissue tags are present
7. Review post op instructions
8. Re-evaluate in 3wks

1. start gentle oral hygiene immediately which includes flossing and mouthrinse
2. light for first couple of days
3. normal diet
4. pain management with NSAIDS or warm salt water

1. >500 CD4+ count
2. may have lymphadenopathy
3. may have dermatologic lesions
4. oral lesion: apthous ulcer, herpes simplex, hairy leukoplakia, cadidosis

1. 200-500 CD4+ count
2. skin and oral lesions-more common
3. recurrent herpes simplex, vericella/zoster, fever, weight loss
4. candida-predictor for pneumocystis carinii pneumonia

1. 50-200 CD4+ count
2. Opportunistic infetions
3. Wasting syndrome
4. Mental disorders
5. Neoplasm

• Bone marrow suppression
• Increased incidence of mouth ulcers and erythema multiforme

1. Higher incidence of erythema multiforme
2. Taste alterations
3. Oral parathesias
4. Benzodiazapines (ie. alprazolam, clonazepam, midazolam, and triazolam): elevated blood levels-increased sedation and respiration depression

• Ecstasy, heroine, cocaine=life-threatening
• Alcohol=reduces effect of drug/increases chance of liver toxicity

1. Increased frequency and recurrence of oral candidosis
2. Diabetes
3. Lipodystrophy
4. Liver toxicity